Quinn Graham E, Ying Gui-Shuang, Repka Michael X, Siatkowski R Michael, Hoffman Robert, Mills Monte D, Morrison David, Daniel Ebenezer, Baumritter Agnieshka, Hildebrand P Lloyd, Schron Eleanor B, Ells Anna L, Wade Kelly, Kemper Alex R
Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
J AAPOS. 2016 Oct;20(5):425-430.e1. doi: 10.1016/j.jaapos.2016.06.007. Epub 2016 Sep 17.
To examine the feasibility of a retinopathy of prematurity (ROP) telemedicine evaluation system of providing timely feedback to a neonatal intensive care unit (NICU) with at-risk premature infants.
This was a prospective observational study of premature infants with birth weights of <1251 g in five NICUs in the United States. Infants scheduled for clinically indicated ROP evaluations underwent indirect ophthalmoscopic examinations and digital imaging on the same day. Imaging was performed by nonphysician retinal imagers. Times required were determined from obtaining digital images of both eyes to submission via web-based system to a secure server for grading by trained readers at a central reading center to sending back grading results to the clinical center.
A total of 1,642 image sets of eyes of 292 infants were obtained, from 823 imaging sessions. The mean turnaround time from submission of image sets of both eyes to return of the grading results to the clinical center was 10.1 ± 11.3 hours (standard deviation), with a median of 12.0 hours (1st quartile, 0.9 hours; 3rd quartile, 16 hours). Overall, 95.5% of gradings (95% CI, 93.9%-96.7%) were returned within 24 hours. Subgroup analyses found, for image sets submitted to the reading center before 2 p.m. Eastern Standard Time, median time to report was 1.7 hours (1st quartile, 0.7 hours; 3rd quartile, 15.5 hours) compared with those submitted after 2pm (median, 14.1 hours; 1st quartile, 11.2, hours; 3rd quartile, 16.3 hours).
An ROP telemedicine approach can provide timely feedback to the NICU regarding the detection of potentially serious ROP and thus referral to an ophthalmologist for examination and consideration of treatment.
探讨一种早产儿视网膜病变（ROP）远程医疗评估系统向有高危早产儿的新生儿重症监护病房（NICU）提供及时反馈的可行性。
这是一项对美国5个NICU中出生体重<1251g的早产儿进行的前瞻性观察研究。计划进行临床指征ROP评估的婴儿在同一天接受间接检眼镜检查和数字成像。成像由非医生视网膜成像人员进行。所需时间从获取双眼数字图像开始计算，直至通过基于网络的系统提交至安全服务器，由中央阅读中心的训练有素的阅片者进行分级，再将分级结果发送回临床中心。
共获得来自292名婴儿的1642套眼图像，来自823次成像检查。从提交双眼图像集到将分级结果返回临床中心的平均周转时间为10.1±11.3小时（标准差），中位数为12.0小时（第一四分位数，0.9小时；第三四分位数，16小时）。总体而言，95.5%的分级结果（95%CI，93.9%-96.7%）在24小时内返回。亚组分析发现，对于在东部标准时间下午2点前提交至阅读中心的图像集，报告的中位时间为1.7小时（第一四分位数，0.7小时；第三四分位数，15.5小时），而下午2点后提交的图像集（中位数，14.1小时；第一四分位数，11.2小时；第三四分位数，16.3小时）。
ROP远程医疗方法可为NICU提供关于潜在严重ROP检测的及时反馈，从而转诊至眼科医生进行检查并考虑治疗。
